EP-1253: Interobserver variability in the target delineation of hepatocellular carcinoma
Eleni Gkika, Stephanie Tandini-Lang, Simon Kirste, Philipp Anton Holzner, H Neeff, H.C. Rischke, Tim Reese, Fabian Lohaus, M.N. Duma, Klaus‐Peter Dieckmann, Robert Semrau, Marcus Stockinger, Detlef Imhoff, Nico Kremers, Michael R. Hafner, Nicolaus H. Andratschke, Ursula Nestle, Anca‐Ligia Grosu, Matthias Gückenberger, T. Brunner · Radiotherapy and Oncology · 2017
Purpose or ObjectiveTo review feasibility and single center experience with stereotactic body radiation therapy (SBRT) in pancreatic adenocarcinoma. Material and MethodsSince February 2014, 15 (p) patients with a median age of 69.8 years (range 53-86) with histologically proven adenocarcinoma of the pancreas were enrolled on this protocol.Six p (40%) were treated with a radical intent, 5 p (33%) as a part of a neoadjuvant treatment and 4 p (27%) under a palliative intention.Prior to radiation, at least 2 gold fiducials markers were located into the tumor guided by endoscopic ultrasound.All the SBRT treatments included CT or PET-CT for GTV delineation, treatment technique was intensity-modulated radiation therapy (IMRT) and daily image-guided radiation therapy (IGRT) with intrafraction control of tumor motion with a Novalis Exactrac Adaptive Gating System.Total dose: 50 Gy in 10 fractions were prescribed in 13 p (87%), 1 p was treated with 35 Gy in 5 fractions and 1 p was treated with 40Gy in 10 fractions. ResultsWith a median follow-up of 8 months (range 3 -24 months), 2 p (13%) are alive without tumor, 4 p (26%) are alive with tumor and 9 p (61%) have died; median overall survival (OS) was 13.4 months (range 8.6 -30.4 months) and the actuarial 12 and 24 months OS was 79% and 22% respectively.Eleven p (73%) remain locally controlled and median time to local progression (PFS) was 11.4 (range 4.5 -30.4 months).The actuarial PFS at 12 and 24 months were 85% and 56% respectively.Pancreatic SBRT was well tolerated in our cohort of patients.No grade 3 or higher toxicity was observed.Six p (40%) developed grade 2 epigastric pain and/or grade 2 nausea/vomiting.Conclusion In our experience, gating SBRT for pancreatic tumor is a feasible and well-tolerated treatment.Most patients are free from local progression, but overall survival remains poor.Prospective studies are needed to define the role of SBRT for pancreatic tumors.